Maximizing MACRA with Medicare ACOs and Bundled Payments

When it comes to the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Quality Payment Program (QPP), participating in the Medicare Share Savings Program (MSSP) or the Bundled Payments for Care Improvement Advanced (BPCI Advanced) model can help providers realize optimal reimbursement. For those analyzing the options for participation in a Medicare ACO or the BPCI Advanced model, it is important to understand their alignment with MACRA.

As MACRA drives physicians to improve their ability to either perform well in the Merit-based Incentive Payment System (MIPS) or be part of an Advanced alternative payment model (APM), both the MSSP and BPCI Advanced models can help improve performance.

How ACOs and Bundled Payments Create Advantages under MACRA

Just by participating in either of these models, organizations can gain significant reporting advantages, as well as access to unblinded and comprehensive claims data to assess performance; the ability to better align with clinicians; certain fraud and abuse waivers that support care quality and coordination; and the potential to earn shared savings payments, even with no downside risk. Participation in multiple Advanced APMs can also enhance a providers’ ability to meet certain QPP criteria.

Specifically, BPCI Advanced qualifies participants as Advanced APMs. Participants that pursue this approach will be eligible for a 5 percent bonus for professional fee payments, making it a valuable tool to assist health systems with physician network alignment. The MSSP, which also supports greater physician alignment, can help providers achieve high performance in the QPP as participants can qualify for a MIPS-APM to reduce administrative burden and improve scoring. Both models also allow health systems to get out ahead of disruptors, which are organizing independent clinicians to create ACOs and bundled payment models that potentially leave hospitals as a cost center.

Optimizing APM Participation

There are intricacies to be aware of when applying for and participating in BPCI Advanced, for example, as different participation types (e.g. Convener, Non-Convener Hospital, and Non-Convener PGP) will impact the chosen MACRA payment model.

The way in which an organization participates in BPCI Advanced can be a complex decision. Successful organizations factor in provider alignment, opportunity, and MACRA benefits, as well as how participating in multiple Advanced APMs will increase the probability of an individual Eligible Clinician’s ability to meeting the required qualifying APM threshold. For example, in BPCI Advanced:

Hospitals can only confer APM benefits to individual Eligible Clinicians.

Physicians Groups can receive APM benefits at a group level.

PGPs can qualify as MIPS-APMs, which provides major significant benefits under MACRA.

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